Preview Form for "The Benefits of Breastfeeding" Video

FREE PREVIEW FORM for the award-winning educational video "THE BENEFITS OF BREASTFEEDING" featuring Dr. Ruth Lawrence PRINT THIS PAGE and fill out completely FAX your preview request - 24 hr Faxline or MAIL your preview request	Volume Discounts 5 or more	Only $59.00 plus $5.00 shipping/ handling
Name_________________________________________________________	Fax Form to: 919-779-7284 or Mail Form to: Eagle Video Productions 2201 Woodnell Drive Raleigh NC 27603-5240 Questions/Comments 1-800-838-5848
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q I understand that this tape is a "WHY TO" video NOT a "HOW TO" video q circle one ENGLISH VERSION or SPANISH VERSION q circle one DVD or VHS q I WANT A FREE 10 DAY PREVIEW ______________________________________________ Signature Authorization Date q I understand that I need to provide ONE of the FOLLOWING requirements for the FREE PREVIEW: PURCHASE ORDER # ____________________________________ (fax or mail PO w/ request) CREDIT CARD # _______________________________________ Exp Date _____/______ [to be put on file] circle one VISA or MasterCard COMMENTS:___________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ FOUND OUT ABOUT VIDEO FROM :_________________________________________________________________

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